Provider Demographics
NPI:1013265503
Name:VERMILYA, BART (RAC)
Entity Type:Individual
Prefix:MR
First Name:BART
Middle Name:
Last Name:VERMILYA
Suffix:
Gender:M
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11999 BROOKLYN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-9128
Mailing Address - Country:US
Mailing Address - Phone:517-592-3030
Mailing Address - Fax:517-592-3029
Practice Address - Street 1:11999 BROOKLYN RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230-9128
Practice Address - Country:US
Practice Address - Phone:517-592-3030
Practice Address - Fax:517-592-3029
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000169171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist